Provider Demographics
NPI:1740827450
Name:FORS, MAYA (LVN)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:FORS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 WAGON WHEEL AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5395
Mailing Address - Country:US
Mailing Address - Phone:940-337-7824
Mailing Address - Fax:
Practice Address - Street 1:5325 WAGON WHEEL AVE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5395
Practice Address - Country:US
Practice Address - Phone:940-337-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347864164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse